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Patient predictors of esophageal stricture development after photodynamic therapy.
- Source :
-
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association [Clin Gastroenterol Hepatol] 2008 Mar; Vol. 6 (3), pp. 302-8. Date of Electronic Publication: 2008 Feb 06. - Publication Year :
- 2008
-
Abstract
- Background & Aims: The most common significant adverse event after photodynamic therapy (PDT) with porfimer sodium is esophageal stricture formation. This study assessed whether pretreatment variables, including prior endoscopic therapy for Barrett's esophagus, are associated with post-PDT stricturing.<br />Methods: Data from all patients who had undergone PDT with porfimer sodium for Barrett's esophagus with high-grade dysplasia, intramucosal carcinoma, or T1 cancer at our institution since 1997 were reviewed.<br />Results: One hundred sixteen patients underwent 160 courses of PDT. The incidence of stricture formation after index PDT was 16% (19/116). For all PDT courses, the overall incidence of stricture was 23% (37/160). Stricture rate was significantly higher after a second PDT course compared with index PDT (43% vs 16%, P = .0007). There was no association between post-PDT stricture development and age, gender, body mass index, or prior endoscopic mucosal resection. Patients who developed a stricture had a longer length of Barrett's esophagus before treatment than those who did not develop a stricture (7.7 vs 5.7 cm for index PDT only, P = .025; 7.4 vs 5.7 cm for all PDT courses, P = .007). Length of Barrett's esophagus, multiple PDT courses, and presence of intramucosal carcinoma on pretreatment pathology were independent predictors of post-PDT stricture in a stepwise logistic regression analysis controlling for treatment variables, including treatment length.<br />Conclusions: An increased risk of stricture development was seen after multiple courses of PDT. An association between post-PDT stricture and length of Barrett's esophagus but not treatment length was also found. Endoscopic mucosal resection did not appear to influence the likelihood of stricture development after porfimer sodium-based PDT.
- Subjects :
- Aged
Barrett Esophagus pathology
Barrett Esophagus therapy
Dihematoporphyrin Ether therapeutic use
Esophageal Neoplasms pathology
Esophageal Neoplasms therapy
Esophageal Stenosis diagnosis
Esophageal Stenosis epidemiology
Female
Follow-Up Studies
Humans
Incidence
Male
Neoplasm Staging
Odds Ratio
Photosensitizing Agents therapeutic use
Prognosis
Retrospective Studies
Dihematoporphyrin Ether adverse effects
Esophageal Stenosis etiology
Photosensitizing Agents adverse effects
Phototherapy adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1542-7714
- Volume :
- 6
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
- Publication Type :
- Academic Journal
- Accession number :
- 18255349
- Full Text :
- https://doi.org/10.1016/j.cgh.2007.12.001